Limits...
Antielevation syndrome after unilateral anteriorization of the inferior oblique muscle.

Cho YA, Kim JH, Kim S - Korean J Ophthalmol (2006)

Bottom Line: Unilateral IOAT may result in antielevation syndrome.Therefore bilateral IOAT is recommended to balance antielevation in both eyes.A meticulous caution is needed when performing unilateral IOAT.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. earth317@yahoo.co.kr

ABSTRACT

Purpose: To report antielevation syndrome with restriction of elevation on abduction in the operated eye and overaction (OA) of the inferior oblique muscle (IO) of the contralateral eye after unilateral IO anteriorization (AT).

Methods: Medical records were reviewed retrospectively in 8 of 24 patients who underwent unilateral IOAT. Four patients were referred from other hospitals after the same surgery.

Results: Four patients had infantile esotropes. The rest showed accommodative esotropia, superior oblique palsy, exotropia, and consecutive exotropia. The mean amount of hyperdeviation was 16.3 PD (10 approximately 30). The mean restriction of elevation on abduction in the operated eye was -1.6 (-1 approximately -4) and IOOA of the contralateral eye was +2.7 (+2 approximately +3). IOAT of nonoperated eyes in 4 patients, IO weakening procedure of anteriorized eyes in 2 patients, and IO myectomy on an eye with IOAT in 1 patient were performed. Ocular motility was improved after surgery in all patients.

Conclusions: Unilateral IOAT may result in antielevation syndrome. Therefore bilateral IOAT is recommended to balance antielevation in both eyes. A meticulous caution is needed when performing unilateral IOAT.

Show MeSH

Related in: MedlinePlus

Patient No. 5 was referred to our hospital after 10 mm recession of the right inferior oblique muscle (IO) and anteriorization of the left IO. He showed limitation of elevation of the left eye, especially in abduction, and overaction of the IO and superior rectus muscle in the right eye (antielevation syndrome). At surgery, the posterior half of the prerecessed IO of the right eye was intact and was only recessed 10 mm to equalize it with the anterior half of the IO fiber.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2908826&req=5

Figure 3: Patient No. 5 was referred to our hospital after 10 mm recession of the right inferior oblique muscle (IO) and anteriorization of the left IO. He showed limitation of elevation of the left eye, especially in abduction, and overaction of the IO and superior rectus muscle in the right eye (antielevation syndrome). At surgery, the posterior half of the prerecessed IO of the right eye was intact and was only recessed 10 mm to equalize it with the anterior half of the IO fiber.

Mentions: IOAT was performed in the contralateral eye with IOOA to produce a symmetrical IOAT status in both eyes of 3 patients from our hospital, including case 1 (Fig. 1). One patient was lost to follow-up after IOAT. Of the 4 referred patients, 2 patients underwent 14 mm recession of the anteriorized IO. One patient who had undergone IOAT of the left eye and 10 mm recession of the IO in the right eye showed severe limitation of elevation of the left eye in abduction and IOOA of the right eye. The operative finding revealed that only the anterior half of the IO fiber of the right eye was recessed by 10 mm, and the posterior half of the fiber was well preserved in the original course with intact scleral insertion behind the lateral rectus muscle (LR). This caused antielevation syndrome (Case 2, Fig. 2).


Antielevation syndrome after unilateral anteriorization of the inferior oblique muscle.

Cho YA, Kim JH, Kim S - Korean J Ophthalmol (2006)

Patient No. 5 was referred to our hospital after 10 mm recession of the right inferior oblique muscle (IO) and anteriorization of the left IO. He showed limitation of elevation of the left eye, especially in abduction, and overaction of the IO and superior rectus muscle in the right eye (antielevation syndrome). At surgery, the posterior half of the prerecessed IO of the right eye was intact and was only recessed 10 mm to equalize it with the anterior half of the IO fiber.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908826&req=5

Figure 3: Patient No. 5 was referred to our hospital after 10 mm recession of the right inferior oblique muscle (IO) and anteriorization of the left IO. He showed limitation of elevation of the left eye, especially in abduction, and overaction of the IO and superior rectus muscle in the right eye (antielevation syndrome). At surgery, the posterior half of the prerecessed IO of the right eye was intact and was only recessed 10 mm to equalize it with the anterior half of the IO fiber.
Mentions: IOAT was performed in the contralateral eye with IOOA to produce a symmetrical IOAT status in both eyes of 3 patients from our hospital, including case 1 (Fig. 1). One patient was lost to follow-up after IOAT. Of the 4 referred patients, 2 patients underwent 14 mm recession of the anteriorized IO. One patient who had undergone IOAT of the left eye and 10 mm recession of the IO in the right eye showed severe limitation of elevation of the left eye in abduction and IOOA of the right eye. The operative finding revealed that only the anterior half of the IO fiber of the right eye was recessed by 10 mm, and the posterior half of the fiber was well preserved in the original course with intact scleral insertion behind the lateral rectus muscle (LR). This caused antielevation syndrome (Case 2, Fig. 2).

Bottom Line: Unilateral IOAT may result in antielevation syndrome.Therefore bilateral IOAT is recommended to balance antielevation in both eyes.A meticulous caution is needed when performing unilateral IOAT.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. earth317@yahoo.co.kr

ABSTRACT

Purpose: To report antielevation syndrome with restriction of elevation on abduction in the operated eye and overaction (OA) of the inferior oblique muscle (IO) of the contralateral eye after unilateral IO anteriorization (AT).

Methods: Medical records were reviewed retrospectively in 8 of 24 patients who underwent unilateral IOAT. Four patients were referred from other hospitals after the same surgery.

Results: Four patients had infantile esotropes. The rest showed accommodative esotropia, superior oblique palsy, exotropia, and consecutive exotropia. The mean amount of hyperdeviation was 16.3 PD (10 approximately 30). The mean restriction of elevation on abduction in the operated eye was -1.6 (-1 approximately -4) and IOOA of the contralateral eye was +2.7 (+2 approximately +3). IOAT of nonoperated eyes in 4 patients, IO weakening procedure of anteriorized eyes in 2 patients, and IO myectomy on an eye with IOAT in 1 patient were performed. Ocular motility was improved after surgery in all patients.

Conclusions: Unilateral IOAT may result in antielevation syndrome. Therefore bilateral IOAT is recommended to balance antielevation in both eyes. A meticulous caution is needed when performing unilateral IOAT.

Show MeSH
Related in: MedlinePlus